SCQ1
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Please select the item that most accurately describes your overall current health. (Circle only one.) |
SCQ2_1
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Can you go out by yourself, using buses or trains? |
SCQ2_2
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Can you shop for daily needs? |
SCQ2_3
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Can you draw your own bath at night? |
SCQ2_4
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Can you pay your bills? |
SCQ2_5
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Can you make deposits and withdrawals from your bank or postal account? |
SCQ2_6
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Can you fill out documentation for your pension, etc.? |
SCQ2_7
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Do you read a newspaper? |
SCQ2_8
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Do you read books or magazines? |
SCQ2_9
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Are you interested in articles or programs about health? |
SCQ2_10
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Do you visit the homes of friends? |
SCQ2_11
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Do you give advice to family or friends? |
SCQ2_12
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Can you visit sick people? |
SCQ2_13
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Do you ever talk to young people? |
SCQ2_14
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Do you use the telephone by yourself? |
SCQ2_15
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Do you take medicine by yourself? |
SCQ3
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How much time you spend walking, including shopping, going to work or going out. |
SCQ4
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Do you regularly use tobacco, or did you use it in the past? (Circle only one answer.) |
SCQ4_1
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At about what age did you begin smoking regularly? |
SCQ4_2
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About how many cigarettes do you smoke per day (or did you used to smoke per day)? (Answer in number of cigarettes or number of packs.) |
SCQ4_3
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At about what age did you quit smoking? |
SCQ5
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We would now like to ask about your alcohol consumption. In the past six months, about how frequently did you drink alcohol (including beer, mixed drinks, whiskey, shochu, sake, or wine)? |
SCQ5_1
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On days when you drank, what and how much did you drink? If you drank more than one kind of drink, please count the total you drank per day. |
SCQ6
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Are you currently concerned about your health? |
SCQ7
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Are you confident that you will be healthy three years from now? |
SCQ8_1
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Felt unusual in some way 1 2 3 4 |
SCQ8_2
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Had no appetite |
SCQ8_3
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Felt depressed and could not be consoled by family or friends |
SCQ8_4
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Felt I could do anything a normal person could do |
SCQ8_5
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Could not concentrate on what I was doing |
SCQ8_6
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Felt depressed |
SCQ8_7
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Something that is normally effortless was difficult to do |
SCQ8_8
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Felt the future was bright |
SCQ8_9
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Felt that my life so far has been a failure |
SCQ8_10
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Felt frightened |
SCQ8_11
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Could not sleep well |
SCQ8_12
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Felt happy |
SCQ8_13
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Felt more taciturn than usual |
SCQ8_14
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Felt lonely |
SCQ8_15
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People around me seemed cold to me |
SCQ8_16
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Felt happy |
SCQ8_17
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Cried or felt like crying |
SCQ8_18
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Felt sad. |
SCQ8_19
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Felt that people around me disliked me |
SCQ8_20
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Didn't feel like doing anything |
SCQ9
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Are you satisfied or unsatisfied with your current life? (Circle only one answer.) |
SCQ10_1
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Spouse (or common-law spouse) |
SCQ10_2
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Relatives living in your house other than spouse |
SCQ10_3
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Children or other close relatives not living with you |
SCQ10_4
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Friends, acquaintances, neighbors, etc. |
SCQ11_1
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Spouse (or common-law spouse) |
SCQ11_2
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Relatives living in your house other than spouse |
SCQ11_3
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Children or other close relatives not living with you |
SCQ11_4
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Friends, acquaintances, neighbors, etc |
SCQ12_1
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Spouse (or common-law spouse) |
SCQ12_2
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Relatives living in your house other than spouse |
SCQ12_3
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Children or other close relatives not living with you |
SCQ12_4
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Friends, acquaintances, neighbors, etc |
SCQ13_1
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Spouse (or common-law spouse) |
SCQ13_2
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Relatives living in your house other than spouse |
SCQ13_3
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Children or other close relatives not living with you |
SCQ13_4
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Friends, acquaintances, neighbors, etc |
SCQ14_1
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Care of children |
SCQ14_2
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Make income |
SCQ14_3
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Prepare meals, clean house, do laundry |
SCQ14_4
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Care of older relatives |
SCQ14_5
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Keep household accounts |
SCQ14_6
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Decide on major purchases |
SCQ15
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How satisfied are you overall with your relationship with your spouse? |
SCQ16_1
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Men should work outside the home and women inside the home |
SCQ16_2
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Boys and girls should be raised differently |
SCQ16_3
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Women are more suited than men for housework and childcare |
SCQ17_1
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Responsibility for social needs of elderly |
SCQ17_2
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Responsibility for medical care of elderly |
SCQ18_1
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Pharmacy and medical care facilities nearby |
SCQ18_2
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Shops selling groceries and daily needs nearby |
SCQ18_3
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Park where you can walk and exercise safely nearby |
SCQ18_4
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Train station or bus stop nearby |
SCQ18_5
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There are pollution or noise problems |
SCQ18_6
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There are concerns about public order such as vandalism or crime |
SCQ18_7
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There is a location nearby to meet with friends |
SCQ19_1
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Do you think you can trust most of them? |
SCQ19_2
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Do you think that others would take advantage of you given the opportunity? |
SCQ19_3
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Do you think most of them try to help others? |
SCQ20
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When you thought of the area “near you” in the previous question, which of the following came to your mind? (Circle only one answer.) |
SCQ21_1
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About how much time per day did you spend on the following activities past monthon weekdays? Commuting |
SCQ21_2
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Work |
SCQ21_3
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Housework, shopping for daily needs, caring for children or grandchildren |
SCQ21_4
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Caring for parent, spouse, or family member |
SCQ21_5
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Exercise, sports, walking |
SCQ21_6
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Studying/learning |
SCQ21_7
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Community meetings, religious activities, political activities |
SCQ21_8
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Hobbies, amusements, socializing |
SCQ21_9
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Resting, relaxing |
SCQ22_1
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We would now like to ask about your friendships. Context in which you met of male friends Know from childhood or school days |
SCQ22_2
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Know from work |
SCQ22_3
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Know from hobby or volunteer activity |
SCQ22_4
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Know through spouse or children |
SCQ22_5
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Met through friend after graduating from schoo |
SCQ22_6
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Live nearby |
SCQ22_7
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Other: (Describe: ) |
SCQ22_8
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How many male friends in all? Know from childhood or school days |
SCQ22_9
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Know from work |
SCQ22_10
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Know from hobby or volunteer activity |
SCQ22_11
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Know through spouse or children |
SCQ22_12
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Met through friend after graduating from school |
SCQ22_13
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Live nearby |
SCQ22_14
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Other: (Describe: ) |
SCQ22_15
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Number of male friends with whom you would share concerns, etc.Know from childhood or school days |
SCQ22_16
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Know from work |
SCQ22_17
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Know from hobby or volunteer activity |
SCQ22_18
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Know through spouse or children |
SCQ22_19
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Met through friend after graduating from schoo |
SCQ22_20
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Live nearby |
SCQ22_21
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Other: (Describe: ) |
SCQ22_22
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Number of male friends you could ask for help if you were sick, injured or hadsome other problem.Know from childhood or school days |
SCQ12_23
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Know from work |
SCQ22_24
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Know from hobby or volunteer activity |
SCQ12_25
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Know through spouse or children |
SCQ22_26
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Met through friend after graduating from school |
SCQ22_27
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Live nearby |
SCQ22_28
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Other: (Describe: ) |
SCQ22_29
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Other: (Describe: ) |
SCQ22_30
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Context in which you met of female friendsKnow from childhood or school days |
SCQ22_31
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Know from work |
SCQ22_32
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Know from hobby or volunteer activity |
SCQ22_33
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Know through spouse or children |
SCQ22_34
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Met through friend after graduating from school |
SCQ22_35
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Other: (Describe: ) |
SCQ22_36
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How many female friends in all? Know from childhood or school days |
SCQ22_37
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Know from work |
SCQ22_38
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Know from hobby or volunteer activity |
SCQ22_39
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Know through spouse or children |
SCQ22_40
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Met through friend after graduating from school |
SCQ22_41
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Live nearby |
SCQ22_42
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Other: (Describe: ) |
SCQ22_43
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Number of female friends with whom you would share concerns, etc. Know from childhood or school days |
SCQ22_44
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Know from work |
SCQ22_45
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Know from hobby or volunteer activity |
SCQ22_46
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Know through spouse or children |
SCQ22_47
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Met through friend after graduating from schoo |
SCQ22_48
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Live nearby |
SCQ22_49
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Other: (Describe: ) |
SCQ22_50
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Number of female friends you could ask for help if you were sick, injured or hadsome other problem. Know from childhood or school days |
SCQ22_51
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Know from work |
SCQ22_52
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Know from hobby or volunteer activity |
SCQ22_53
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Know through spouse or children |
SCQ22_54
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Met through friend after graduating from school |
SCQ22_55
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Live nearby |
SCQ22_56
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Other: (Describe: ) |
SCQ22_57
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Other: (Describe: ) |
SCQ23
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Overall, are you satisfied with your current friendships? |
SCQ24
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In the past month, have you done non-work activities with anyone other thanfamily or friends? |
SCQ24_1
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What kind of activity was it? Please select all applicable answers. |
SCQ24_2
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Enter the number of the activity above you engaged in most frequently: |
SCQ24_3
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About how often did you engage in the activity you named in question 24-2? (Circle only one answer.) |
SCQ25
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We would now like to ask about your contributions to and support of charitable enterprises. In the past year, have you contributed to a charity? If so, about how much did you donate? A rough estimate is fine. |
SCQ26
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Do you manage your household finances together with your spouse (or common-law spouse), or separately? |
SCQ27
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About how much income did you have in the last year after taxes and social insurance deductions? Please include not only wages, but any income from pensions or financial assets (fixed-term savings, government bonds, etc.) or real estate in your name. |
SCQ28
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We would now like to ask about any taxes or social insurance premiums paid in your own name. In the past year, did you pay any income tax, resident tax, business tax, fixed-asset tax, automobile tax, inheritance tax, or social insurance premiums |
SCQ28_1
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Only for respondents who answered “Yes” to question 28. In the past year, about how much did you pay all together? If you can, circle any items you paid and state the amount. If you can distinguish between taxes and social insurance deductions, please do |
SCQ29
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We would now like to ask about your spouse’s income. About how much income did your spouse have in the last year after taxes and social insurance deductions? Please include not only wages, but any income from pensions or financial assets (fixed-term savin |
SCQ30
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We would now like to ask about any taxes or social insurance premiums paid in your spouse’s name. In the past year, did your spouse pay any income tax, resident tax, business tax, fixed-asset tax, automobile tax, inheritance tax, or social insurance premi |
SCQ30_1
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Only for respondents who answered “Yes” to question 30. In the past year, about how much did your spouse pay all together? If you can, circle any items your spouse paid and state the amount. If you can distinguish between taxes and social insurance deduc |
SCQ31
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Do you manage your assets together with your spouse (or common-law spouse) or separately? |
SCQ32
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Do you have savings in your own name? Please include regular bank or postal savings accounts, and fixed-term and fixed-amount accounts (including credit unions, credit societies, agricultural cooperatives, credit banks, etc.). |
SCQ33
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Do you own securities in your own name in an investment trust (MMF, medium-term government bond fund, foreign investment trust, etc.), discount bank debentures, wide funds, government bonds, corporate securities, etc.? |
SCQ33_1
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This question is only for respondents who answered “Yes” to question 33. About how much do you have in those accounts? |
SCQ34
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Do you own in your own name securities that can be traded through an investment company? |
SCQ34_1
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This question is only for respondents who answered “Yes” to question 34. If you sold all those securities today, about how much could you get for them? |
SCQ35
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Does your spouse have savings in his or her own name? Please include regular bank or postal savings accounts, and fixed-term and fixed-amount accounts (including credit unions, credit societies, agricultural cooperatives, credit banks, etc.). |
SCQ35_1
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This question is only for respondents who answered “Yes” to question 35. About how much does your spouse have in those accounts? |
SCQ36
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Does your spouse own securities in his or her own name in an investment trust (MMF, medium-term government bond fund, foreign investment trust, etc.), discount bank debentures, wide funds, government bonds, corporate securities, etc.? |
SCQ36_1
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This question is only for respondents who answered “Yes” to question 36. About how much does your spouse have in those accounts? |
SCQ37
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Does your spouse own in his or her own name securities that can be traded through an investment company? |
SCQ37_1
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This question is only for respondents who answered “Yes” to question 37. If your spouse sold all those securities today, about how much could he or she get for them? |
SCQ38
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This concludes the questionnaire. Did you answer this questionnaire on your own, or with the assistance of a family member or caregiver? (Circle only one answer.) |